Oterdoom Leendert H, de Vries Aiko P J, van Ree Rutger M, Gansevoort Ron T, van Son Willem J, van der Heide Jaap J Homan, Navis Gerjan, de Jong Paul E, Gans Reinold O B, Bakker Stephan J L
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Transplantation. 2009 May 27;87(10):1562-70. doi: 10.1097/TP.0b013e3181a4bb80.
Mortality rates are higher in renal transplant recipients (RTR) than in the general population (GP). It is unknown what risk factors account for this difference.
We prospectively followed a cohort of 606 RTR for 3026 person-years, during which 95 died. A GP cohort of 3234 subjects was followed for 24,940 person-years, during which 130 died.
All investigated risk factors, except ethnicity, body mass index, and total cholesterol, differed significantly between cohorts, with an adverse risk profile in the RTR. The age-adjusted and gender-adjusted hazard ratio for mortality in RTR was 6.2 (95% confidence interval [CI] 4.6-8.3) compared with GP, which was reduced to 2.4 (95% CI 1.6-3.6), 4.3 (95% CI 3.0-6.1), and 5.0 (95% CI 3.5-7.3) after additional adjustment for differences in N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatinine clearance, and need for antihypertensive medication, respectively (all P<0.001), whereas adjustment for variables more related to atherosclerosis, including history of cardiovascular disease, diabetes, and high-density lipoprotein cholesterol, did not affect the difference in mortality between RTR and GP. Associations of NT-proBNP, creatinine clearance, and the use of antihypertensive medication with mortality were significantly steeper in RTR than in GP. Risk for mortality was similar for RTR and GP with low NT-proBNP (<100 pg/mL).
Elevated NT-proBNP, low creatinine clearance, and need for antihypertensive medication are stronger risk factors for mortality in RTR than in GP. The increased mortality seen in the RTR population may well be related to cardiac failure rather than "accelerated atherosclerosis."
肾移植受者(RTR)的死亡率高于普通人群(GP)。目前尚不清楚导致这种差异的风险因素有哪些。
我们对606名RTR进行了前瞻性队列研究,随访3026人年,期间有95人死亡。对3234名受试者组成的GP队列进行了24940人年的随访,期间有130人死亡。
除种族、体重指数和总胆固醇外,所有调查的风险因素在两个队列之间均存在显著差异,RTR的风险状况更为不利。与GP相比,RTR经年龄和性别调整后的死亡风险比为6.2(95%置信区间[CI]4.6 - 8.3),在进一步调整N末端B型利钠肽原(NT-proBNP)、肌酐清除率和抗高血压药物使用差异后,分别降至2.4(95%CI 1.6 - 3.6)、4.3(95%CI 3.0 - 6.1)和5.0(95%CI 3.5 - 7.3)(均P<0.001),而调整与动脉粥样硬化更相关的变量,包括心血管疾病史、糖尿病和高密度脂蛋白胆固醇,并未影响RTR和GP之间的死亡率差异。NT-proBNP、肌酐清除率和抗高血压药物使用与死亡率的关联在RTR中比在GP中显著更强。NT-proBNP水平低(<100 pg/mL)的RTR和GP的死亡风险相似。
NT-proBNP升高、肌酐清除率降低和需要使用抗高血压药物是RTR比GP更强的死亡风险因素。RTR人群中观察到的死亡率增加很可能与心力衰竭有关,而非“加速动脉粥样硬化”。